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Surgical MCQs > Chemical peels > Flashcards

Chemical peels Flashcards

1
Q

In chemical peels, the agent used is usually an acidic solution.

A

T

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2
Q

For patients with extensive AKs, superficial peels should be used.

A

F Medium-depth peels.

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3
Q

Pre-treatment with tretinoin or AHAs is contraindicated prior to chemical peels.

A

F

recommended for 4-6 wks prior

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4
Q

Superficial peels penetrate to the epidermis/papillary dermis.

A

T

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5
Q

Medium peels can penetrate to the mid-reticular dermis.

A

F

Upper reticular dermis.

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6
Q

Deep peels can penetrate to the deep-reticular dermis.

A

F

mid-reticular dermis.

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7
Q

UVA radiation penetrates deeper in the skin than UVB

A

T

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8
Q

Topical tretinoin pre-treatment prolongs wound healing after medium-depth and deep-depth chemical peels.

A

F

Accelerates wound healing.

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9
Q

AHAs exert their epidermal effect at the level of the stratum corneum and granulosum junction.

A

T

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10
Q

AHAs can reverse the histologic signs of photoageing.

A

T

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11
Q

Sunscreens should be used regularly for 3 months prior to a chemical peel and continued indefinitely after the peel.

A

T

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12
Q

Hydroquinone should not be used prior to chemical peels.

A

F

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13
Q

Prophylactic antivirals are not needed prior to chemical peels.

A

F

Start day prior to peel, continue 10-14days.

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14
Q

Risks of chemical peels include stinging, burning sensation, visible peeling, scaling, milia formation, pigmentary changes, persistent erythema, infections and rarely scarring.

A

T

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15
Q

Persistent erythema is a sign of impending scarring

A

T

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16
Q

The use of AHAs has been shown to reverse histologic signs of photoaging

A

T

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17
Q

Used regularly for 3/12 AHAs showed a 25% increase in epidermal and papillary thickness, increase in mucopolyaccharides, improved quality of elastic fibres and increased collagen density

A

F

6/12

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18
Q

Active viral, bacterial or fungal infection preclude chemical peeling until there is complete resolution.

A

T

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19
Q

It is safe to perform a chemical peel if isotretinoin has been taken anytime prior to the procedure.

A

F

Must wait 6-12 months (impaired wound healing, increased risk of scarring).

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20
Q

The AHAs have been used as an adjunct to tretinoin therapy without increasing adverse sequelae

A

T

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21
Q

Patients who’ve had prior facial XRT are at higher risk for scarring after chemical peels.

A

T

Due to diminished adnexal structures (from where re-epithelialisation originates).

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22
Q

There is no need to delay chemical peels after facial surgery.

A

F

Should wait 6 months or more.

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23
Q

Smokers have increased rates of infection after chemical peels.

A

T

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24
Q

Superficial chemical peels work by exfoliating all or part of the epidermis, which leads to mild stimulation of collagen formation in the superficial papillary dermis.

A

T

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25
Q

Melasma, ephelides and post-inflammatory hyperpigmentation are not indications for superficial peeling.

A

F

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26
Q

Acne vulgaris is an indication for superficial chemical peel

A

T

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27
Q

Photoaging and fine rhytides are an indication for superficial chemical peel.

A

T

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28
Q

There is usually a significant effect noted after one superficial chemical peel.

A

F

Usually need 3-6 peels, in conjunction with topical home regimen

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29
Q

Multiple superficial peels will produce the same result as one deeper chemical peel.

A

F

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30
Q

Tretinoin should not be used topically for 2-4 days prior to a superficial chemical peel

A

T

To ensure intact epidermis

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31
Q

A bleaching agent should not be used in patients with darker skin types or pigmentary disorders until after the chemical peel.

A

F

Best to start prior to peeling.

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32
Q

Without topical agents, the skin will return to before-peel condition within 2 years.

A

T

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33
Q

Superficial chemical peels can be used on all Fitzpatrick skin types.

A

T

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34
Q

Glogau’s classification is a measure of photoageing.

A

T

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35
Q

Sebaceous gland density does not effect the depth of a peel.

A

F

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36
Q

The area treated does not effect the depth of a peel

A

F

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37
Q

The technique of application is a significant determinant of the depth of a peel

A

T

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38
Q

The sable brush has been shown to deliver the greatest quantity of solution when used as a peel applicator.

A

T

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39
Q

The response to a chemical peel is not affected by pressure or rubbing during application

A

F

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40
Q

The condition of the skin and the skin preparation technique can influence the depth of peeling

A

T

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41
Q

Seborrhoeic dermatitis may cause a peeling solution to penetrate less deeply

A

F

More deeply

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42
Q

Thicker and more sebaceous skin is less susceptible to the peeling agent.

A

T

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43
Q

Non-facial areas can be treated with peeling agents of any depth

A

F

Should only use superficial peeling agents

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44
Q

When peeling with AHA agents, the concentration of the solution is increased and the length of time that the acid is left on is reduced

A

T

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45
Q

Hand-held fans can be utilised effectively to minimise discomfort during a chemical peel.

A

T

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46
Q

Trichoroacetic acid 10-50% is a commonly used superficial peeling agent.

A

F

10-25%.

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47
Q

If the frost from TCA is unexpectedly rapid or intense water neutralization may dilute the effect if applied within 1 minute

A

F

Within 30 seconds

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48
Q

A solution of TCA 25% consists of 25g in 100mL of normal saline

A

F

Distilled water

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49
Q

With lower concentrations of TCA, mild erythema or whitish speckling may be evident

A

T

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50
Q

Repeated applications of TCA may be made to areas that don’t frost.

A

T

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51
Q

If frosting is rapid or intense after TCA application, the effect can be diluted if water is applied within 2 minutes.

A

F

Within 30 seconds

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52
Q

If stinging occurs after TCA application, it tends to crescendo for 2 minutes, then subside.

A

T

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53
Q

White frosting produced by TCA resolves within 1-2 days.

A

F

1-2 hours

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54
Q

Light peels can be performed weekly for acne vulgaris at concentrations of 10-15% TCA with minimal downtime.

A

T

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55
Q

Applications of 25-35% TCA may take 14 days to heal within darkening of the face for 5-7 days and fine desquamation on days 3-6.

A

F

5-7 days to heal, darkening for 2-3 days.

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56
Q

Jessner’s solution consists of: resorcinol 14g, salicylic acid 14g, lactic acid 14g, and ethanol 95% per 100ml.

A

T

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57
Q

The salicylic acid in Jessners solution fluoresces under the woods light, which is another method that can be used to ensure even cover

A

T

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58
Q

Frosting usually occurs with Jessner’s solution application.

A

F

Just erythema and white speckling.

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59
Q

Jessner’s peels are usually followed by 2-3 days of light white desquamation.

A

T

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60
Q

AHAs are naturally occurring organic acids extracted from fruit, sugar cane, and other foods.

A

T

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61
Q

Glycolic acid is the most commonly used AHA in superficial peeling.

A

T

62
Q

AHAs cannot be used on Fitzpatrick skin type IV-VI.

A

F

63
Q

Glycolic acid 70% peels have been shown to be equivalent to Jessner’s solution for efficacy in active acne.

A

T

64
Q

For AHA peels, low pH solutions (pH2) create more necrosis and improve efficacy

A

F

More necorsis without improving efficacy.

65
Q

70% glycolic acid can be used unbuffered and unneutralised.

A

T

66
Q

An abrasive skin cleansing regimen should be used prior to AHA peels in order to de-grease the skin.

A

F

Should avoid – can increase depth of penetration.

67
Q

Glyocolic acid should be applied with cotton balls rather than gauze to avoid abrasive effects of rubbing.

A

T

68
Q

It is unnecessary for the physician to stay in the room during an AHA peel

A

F

Need to observe for ‘hot spot’ erythema.

69
Q

AHA can be neutralised with a 5% sodium bicarbonate solution with multiple rinses.

A

T

70
Q

Indicators to neutralise the AHA solution include unusual degree of patient discomfort, mild erythema, or adequate time interval.

A

T

71
Q

Time dependency is not a factor in glycolic acid peeling.

A

F

Unique factor must time and neutralise this peel

72
Q

Salicylic acid can be used solo in 20-30% solutions for superficial peeling.

A

T

73
Q

Salicylic acid peels can cause white precipitation within 2-3 days.

A

F

White precipitation occurs immediately.

74
Q

Salicylic acid peels are self-limiting and there is no need for timing or neutralisation

A

T

75
Q

There is a tendency for great discomfort immediately following salicylic acid chemical peels

A

F

There is very little discomfort due to the anaesthetic properties of SA

76
Q

SA peels may benefit acne more than other peels.

A

T

Because it is also comedolytic.

77
Q

SA peels cannot be used in Fitzpatrick V and VI skin types.

A

F

Can be. Start with 20%, use hydroquinone post Rx

78
Q

SA peels often are prepared with ethanol as a vehicle, which causes redness, stinging and burning.

A

T

Newer polyethylene glycol base less irritant.

79
Q

Solid carbon dioxide can be used as a superficial peel.

A

T

80
Q

Tretinoin cannot be used as a superficial peel.

A

F

Can use 1-5% concentration.

81
Q

Resurfacing techniques are ineffective for the treatment of AKs.

A

F

82
Q

A thin coat of petrolatum or antibiotic ointment should be applied after most peels.

A

T

83
Q

Topical steroid ointment should not be applied after a chemical peel.

A

F

Use if reaction brisk, or type IV/greater skin.

84
Q

Patients should cleanse their face twice daily after a chemical peel and resume their normal skin-care regimen as soon as the skin returns to normal.

A

T

85
Q

A combination of Q-switched alexandrite laser with concomitant superficial TCA peeling can be used for recalcitrant pigmentary disorders.

A

T

Apply peel before laser.

86
Q

Medium-depth peeling is defined as the application of a wounding agent to the skin, producing a wound at or through the level of the papillary dermis.

A

T

87
Q

The injury of medium-depth peeling is associated with coagulation necrosis of the epidermis only.

A

F

Also papillary dermis + inflammation to the reticular dermis.

88
Q

Medium-depth peels are indicated for AKs, superficial seborrhoeic keratoses, lentigines and other pigmentary dyschromia.

A

T

89
Q

TCA with concentrations above 50% is used to achieve a medium-depth peel to the skin.

A

F

35-50% (although 45-50% can have unpredictable effect so rarely used now)

90
Q

35% TCA can be combined with solid CO2, Jessner’s solution or 70% glycolic acid to achieve a medium-depth chemical peel.

A

T

91
Q

88% phenol and pyruvic acid are medium-depth peeling agents.

A

T

92
Q

Benefits of medium-depth peeling can be seen in patients with severe actinic damage and sallow discolouration of the skin with significant wrinkling.

A

F

Moderate actinic damage, without significant wrinkling.

93
Q

Bichloroacetic acid can be used carefully as a spot treatment for conditions such as trichodiscomas, sebaceous hyperplasia, syringomas and trichoepitheliomas.

A

T

94
Q

The uniformity of the application of a Jessner’s solution peel can be identified with a Wood’s lamp

A

T

SA in Jessner’s fluoresces.

95
Q

It is unnecessary to extend a chemical peel into the hairline or below the jawline.

A

F

Feather into these areas to reduce noticeable lines of demarcation.

96
Q

Coarser, more sundamaged skin reacts faster to TCA peels, thus requiring less heavily applied acid.

A

F

Reacts more slowly, requires more heavily applied acid.

97
Q

TCA will penetrate deeper with a more heavily saturated applicator (eg cotton tip).

A

T

98
Q

Two small dry cotton-tipped applicators should be held at the medial and lateral canthus of the eye to catch any tears that may develop during a chemical peel, preventing ‘wicking’ of the acid into the eye.

A

T

99
Q

Once TCA has been applied, there is no period in which it can be diluted prior to keratocoagulation and the frosted appearance.

A

F

About 30 seconds

100
Q

After a medium-depth peel, the skin should be kept greasy with appropriate ointments until desquamation is complete, generally within 5-7 days.

A

T

101
Q

By 8 hours after a medium-depth peel, the skin has a light brown appearance.

A

F

24 hours.

102
Q

Areas of pigmentary dyschromia and freckling appear darker after a medium-depth chemical peel.

A

T

103
Q

After a medium-depth chemical peel, desquamation begins around the hairline.

A

F

Around mouth and central face. Hairline is last area to peel.

104
Q

Peeling usually starts on day 3 after a medium-depth chemical peel and is complete within 1 week.

A

T

105
Q

After a chemical peel, pts should facilitate the peeling process by gentle scrubbing the skin.

A

F

no scrubbing or picking allowed

106
Q

Patients can wear make-up within 2 weeks post medium-depth chemical peel.

A

F

7-10 days.

107
Q

Erythema usually fades within 1-2 weeks post medium-depth chemical peel.

A

F

2-4 weeks.

108
Q

AHAs may be restarted on week 3 after a medium-depth chemical peel, and tretinoin 4-6 weeks after the peel.

A

T

109
Q

Following an AHA peel a 10% sodium bicarbonate solution with multiple rinses is used to neutralize the AHA agent

A

F

5% in Robinson bt can actually use 5-16%

110
Q

The use of botox 7-10 days before a medium-depth peel is prohibited.

A

F Enhances the results.

111
Q

Laser resurfacing to the deeper perioral rhytides complements medium-depth peeling and should always be performed after the peeling, at the end of the procedure

A

T

112
Q

The ideal patient for a deep chemical peel is a thin-skinned woman with fair complexion and generalised wrinkling.

A

T

113
Q

If a deep phenol peel is being considered for the entire face, the patient must have normal hepatorenal and cardiovascular status.

A

T Due to cardiotoxicity of phenol.

114
Q

Deep chemical peels are best suited for facial wrinkles (periocular and periorbital regions), pigmentary dyschromia, AKs and superficial acne scars.

A

T

115
Q

It is not necessary to remove deep facial oils prior to a phenol peel.

A

F

116
Q

A full-face phenol peel should extend over a 30 minute period to avoid cardiac arrhythmias.

A

F 60-90 minutes.

117
Q

No more than 50% of the face should be treated during a 15 minute time period.

A

F 30 minute

118
Q

Cardiac monitoring is not needed during and after a full-face phenol peel.

A

F

119
Q

Upper eyelid peeling should not be carried down below the superior tarsal fold.

A

T

120
Q

Lower eyelid peeling should be done with the patient gazing upward.

A

T

121
Q

It is not necessary to stretch the skin during perioral peeling.

A

F

Allows peel solution to be applied evenly.

122
Q

If deep wrinkles are treated, an open technique is generally better.

A

F

Closed technique of taping – remove at 24hrs.

123
Q

Sun avoidance is recommended for up to 12 weeks after a deep chemical peel to prevent PIH

A

F

Up to 6 months.

124
Q

Skin appears erythematous for up to 12 weeks after a deep chemical peel.

A

T

125
Q

Non-facial skin has decreased adnexal structures, which impairs wound healing.

A

T

126
Q

The ‘Cook total body peel’ consists of applying 70% glycolic acid gel combined with 35% or 40% salicylic acid

A

F
35% or 40% TCA.
NB this peel not in 3rd edition

127
Q

Using the ‘Cook total body peel’ technique, there is no need for neutralisation.

A

F
Neutralise at desired depth with copious 10% sodium bicarbonate solution.
NB this peel not in 3rd edition

128
Q

For the ‘Cook total body peel’, liquid glycolic acid could result in increased scarring.

A

T
Need to use gel – acts as partial barrier to TCA.
NB this peel not in 3rd edition

129
Q

After the ‘Cook total body peel’, the skin flakes for 2-4 weeks.

A

T

NB this peel not in 3rd edition

130
Q

The ‘Cook total body peel’ cannot be used for AKs or DSAP.

A

F

NB this peel not in 3rd edition

131
Q

For mid to deep peels, antiviral prophylaxis should be used in all immunosuppressed patients or those with a history of HSV.

A

T

132
Q

The risks of complications from peels increase proportionately with the depth of the wound.

A

T

133
Q

Lighter peels are more likely to be associated with hypopigmentation and deeper peels with hyperpigmentation.

A

F
Lighter with hyperpigmentation.
Deeper with hypopigmentation.

134
Q

The risk of hyperpigmentation is increased by exogenous oestrogens, photosensitising medications and direct sun exposure during the first 6 weeks after a peel.

A

T

135
Q

Hypopigmentation is an unexpected complication of phenol peels and deeper resurfacing procedures.

A

F

Normal sequela.

136
Q

Accentuation of naevi can occur after peels.

A

T

137
Q

Milia usually occur within the first 1-3 weeks after peels.

A

F

1-3 months.

138
Q

Persistent erythema is closely associated with deeper peels, but may be seen after medium-depth peels and rarely after superficial peels.

A

T

139
Q

Infection is common after chemical peels.

A

F

Rare. Both TCA and phenol are bactericidal.

140
Q

Toxic shock syndrome has been reported in association with phenol-based peels.

A

T

141
Q

Previous medium or deep peels, dermabrasion, or laser resurfacing without waiting 6-12 months can increase the risk of scarring after a chemical peel.

A

T

142
Q

IV hydration during phenol peeling assists in clearing the phenol from the circulation and decreases the likelihood of toxicity.

A

T

143
Q

50% TCA is a medium depth peeling agent

A

T

144
Q

Solid Co2 +35% TCA is a superficial depth peeling agent

A

F

medium

145
Q

Jessner’s solution + 35% TCA is a deep chemical peel

A

F

medium

146
Q

70% glycolic acid +35% TCA is a medium depth peel

A

T

147
Q

88% phenol is a deep chemical peel

A

F

medium

148
Q

Pyruvic acid is a superficial chemical peel

A

F

medium

149
Q

Hypopigmentation is a potential complication of deep peels only

A

T

150
Q

Lighter peels are more commonly associated with hyperpigmentation

A

T

Surgical MCQs (44 decks)

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